Mood stabilisers help stabilise pronounced and prolonged mood shifts, which include hypomanic or manic phases, such as in bipolar disorder I and II. They can also help to a varying degree against depressive episodes as part of a bipolar disorder.
The precise mechanism of action of lithium is unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. The effect of lithium is probably due to the similar properties of lithium ions to potassium ions. In the synapse, lithium decreases norepinephrine release and increases serotonin synthesis.
Lithium is known to inhibit the enzyme GSK-3B, which may increase gene transcription of brain-derived neurotrophic factor (BDNF) and contribute to a better functioning of the circadian rhythm. The possible increased neural plasticity due to an increase in BDNF might also play a role.
Anticonvulsants have inhibitory effects. They mostly block voltage-gated sodium channels, affecting the brain’s glutamate system (which is mainly excitatory), while some may have their main effect on the GABAergic system (which is mainly inhibitory).
Both, lithium and the anticonvulsants, probably have an effect on the arachidonic acid cascade, which plays a role in inflammatory responses, which may also affect mood.
Antipsychotics work primarily by changing the dopamine transmission. This can either directly or indirectly lead to mood stabilisation.
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